This study extends the analysis of my book, Unlikely Entrepreneurs: Catholic Sisters and the Hospital Marketplace, 1865-1925, into the 20th century. The importance of the project lies in its historical approach to the vexed problem of the role that religion should (or should not) play in the American hospital marketplace. It will compare and contrast Catholic hospitals owned and operated by three religious congregations of women and one male order in the Northeast, Midwest, Southwest, and Far West. These include: the Sisters of Providence in the Pacific Northwest, a French-Canadian congregation;the Alexian Brothers in Chicago, who originated in Belgium and Germany as medieval lay mendicants;the Daughters of Charity in Texas, founded by the American-born Elizabeth Seton;and the Sisters of Mercy in the Eastern United States, who initially emigrated from Ireland. The aim is to complete a full-length book manuscript that will examine the problem of how Catholic hospitals were and are simultaneously religious and secular institutions. The book will consider the ways in which that paradox has manifested itself over the later 20th century. The project is especially significant since the Catholic Church is the nation's largest group of not-for-profit healthcare sponsors, systems, and facilities. Employing the framework of social and cultural history, this study examines the significant challenges Catholic hospitals encountered as marketplace values, modernization processes, shifts in religious consciousness, healthcare reform efforts, and federal regulation accelerated. How Catholic hospitals'historical dominance in the not-for-profit healthcare delivery system shaped the current healthcare system will also be a major focus. Through archival research and oral histories, the project will probe the diversity in hospital development according to region (place), race, ethnicity, and gender, while at the same time showing how Catholic hospitals developed a subculture that distinguished them from non-religious hospitals. It will provide a complex illustration of what it means for institutions to encounter drastic change and emerge with a new vision and community purpose.